The “Abdominal” Truth!

Real-Time-UltrasoundThe “Abdominal” Truth!

Many new mums come to our clinic with a diagnosis of Diastasis Recti or abdominal muscle separation.( DRAM) This can be a stressful diagnosis to a busy mum keen to get her pre-baby tummy back. Embarking on random abdominal exercises, sit-ups etc are not the solution and can make the problem a lot worse.

So what is DRAM ?
How will it affect you and whom can you go to for help? Read on!
A DRAM is the separation of the Diastasis Rectus Abdominis Muscle. Although it develops occurs during pregnancy, it is usually noted postpartum,as an indent between the two halves of the abdominal muscles when a woman is lying lying on her back, or as a tenting or bulging when she contracts her belly, as in a sit up.

The linea alba is the line that joins the two halves but during pregnancy, as the fetus grows, the linea alba stretches to accommodate the growing fetus. There is a greater amount of spreading of the linea alba with women who have had more than one baby.
A quick and easy self test to do, if you notice you have a bulge running down the center of your tummy, is to lie on your back and lift your head up: if you see a bulge, or bulge that gets wider, you may have a diastasis.
A certain amount of separation is considered normal, but if the separation is too large then the concern is that the women’s core system ( abs, pelvic floor and deep spine muscles ) may not be able to function properly and therefore result in back and hip pain ,incontinence and poor posture related to inadequate stabilization of the pelvis and lower spine ribs and hips.

The degree of separation can vary amongst women, with a larger gap more often seen when:
– The woman is over 35
– Had a large baby or babies
– Multiple pregnancies
– A pregnancy of multiples

If you are concerned with whether or not you have a diastasis check in with your GP and/or your Ob/Gyn.

So, why is separation a problem? Most people have heard of strengthening the core and know various exercises to do so .However, without engaging the deeper core muscles as a unit, the ability to create tension across the belly and thereby support the spine is significantly diminished. This contributes to back pain, pelvic floor dysfunction, abdominal discomfort, risk of hernias in later life and overall poor lumbopelvic control. In day-to-day life, this can present as poor posture, a leaky bladder and/or a sensation of general deconditioning with tired back or hip muscles when walking hiking or running. DRAM may also be associated with pelvic pain, constipation and difficulties with sexual intercourse.

Assessment and Treatment
It is recommended that any woman who has had a baby see a Registered Physiotherapist with expertise in Women’s Health around 6 weeks post delivery or surgery.
Physiotherapy assessment includes taking a detailed history, examination of the patient’s posture, spine, pelvis, hips and ribs noting movement (too much or too little and quality) muscle strength and flexibility. An internal pelvic floor check is recommended to assess the tone of the deep muscles, in addition to diastasis measurement.
It is difficult to determine whether the deep abdominal muscles are actually engaging by palpating with a hand or even less efficient by visualizing the abdominals. Currently, the use of real time ultrasound (RTUS) is the clearest way for a woman to visualize her stomach muscles. This allows the physiotherapist to determine the degree of separation, and to diagnose ability or inability to contract the deep abdominal muscles. It is an excellent educational tool and a great way to discuss the best manner with which to safely get a women back on the road to exercising in a progressive manner, dependent on their own individual abilities and goals .RTUS is an effective and fun way to see your own muscles at work.

Current research suggests proper assessment and specific abdominal rehabilitation can help women regain their strength and postural alignment. However, if the split is too large surgery may be the answer, such as a tummy tuck, in which they close the gap and
suture it together. At Trimetrics we use Clinical Pilates training for both early and advanced abdominal rehabilitation. If you have concerns about DRAM, pelvic alignment, pelvic floor issues and abdominal strength, Registered Physiotherapists are Trimetrics Physiotherapy are fully equipped to get you safely back to fitness and ease in your post baby body!

The “Abdominal” Truth!

References
Benjamin, D.R.; Van de Water, A.T.M; Peiris, C.L. (March 2014). “Effects of exercise on diastasis of the rectus
abdominis muscle in the antenatal and postnatal periods: a systematic review”. Physiotherapy 100 (1): 1–
8. doi:10.1016/j.physio.2013.08.005. PMID 24268942.
Harms, M.D., Roger W. Why do abdominal muscles sometimes separate during pregnancy? Harms, Roger MD

Kirsten Stalberg B.Physio, M.C.P.A.
CGIMS Practitioner
Certified Pilates Instructor.

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